Healthcare Provider Details

I. General information

NPI: 1093034167
Provider Name (Legal Business Name): MEDEVENT911 LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/27/2010
Last Update Date: 05/27/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16772 W BELL RD SUITE 110-274
SURPRISE AZ
85374-9702
US

IV. Provider business mailing address

16772 W BELL RD SUITE 110-274
SURPRISE AZ
85374-9702
US

V. Phone/Fax

Practice location:
  • Phone: 623-322-1908
  • Fax: 480-247-5512
Mailing address:
  • Phone: 623-322-1908
  • Fax: 480-247-5512

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code146D00000X
TaxonomyPersonal Emergency Response Attendant
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code146N00000X
TaxonomyBasic Emergency Medical Technician
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code146L00000X
TaxonomyParamedic
License Number
License Number State

VIII. Authorized Official

Name: MR. WILLIAM DEE MCCLUSKEY
Title or Position: PRESIDENT/CEO
Credential: CEP
Phone: 623-322-1908